Transcript Slide 1
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Confidential
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Copyright © 2014 TriZetto Corporation
QicLink™
EFT Processing
Susan Scardina – Sr QicLink Product Manager
Laura Gerling – Mgr of Product, Partner & Acct Mgmt
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Copyright © 2014 TriZetto Corporation
Agenda
Purpose and Benefit
Overview
EFT Workflow Overview
Setup
Pre-Note Processing
Electronic Fund Transfer
ACH File Format
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Purpose and Benefit
Electronic Fund Transfer (EFT)
Allow for electronic fund transfers (EFT) in the National
Automated Clearing House Association (NACHA) –
ACH file format
Prearranged Payment and Deposit Entry (PPD)
Benefit – Recipient payments directly
transferred to desired savings/checking
account in lieu of printed checks
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EFT Advantages to Participants
Administrators
Reduction of administration and operating expenses
Reduction of costs for check account reconciliation
Elimination of stop payment and check reissue costs
Recipients
Elimination in time and cost involved to deposit checks
Consistent availability of funds
Vacation
Business trips
Illness
Elimination of lost or stolen checks
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NACHA Participants
Originator
Initiates ACH entries into payment system
Originating Depository Financial Institution (ODFI)
Receives payment instructions from Originator
Forward entries to ACH Operator
Automated Clearing House (ACH) Operator
Central clearing facility
Receiving Depository Financial Institution (RDFI)
Receives and posts entries to participant (receiver) accounts
Receiver
Authorizes an Originator to initiate an ACH entry to the receiver’s
account
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Types of Receivers
Pay-To Enrollees / Members
Unassigned claim payments
Disability payments
Flexible Spending payments
Billing Vendor
Agent Commissions
Capitation Providers
** EFT claim payments for providers via 835 process only
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Illustration of ACH Credit Flow
ODFI
Originator
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ACH Operator
RDFI
Receiver
EFT Workflow
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EFT Process
Pre-notification (pre-note) sent through ACH network
Non-dollar entry
Alert RDFI of future live dollar transactions
Verification of Receiver’s account number
14-day “quiet” period
Allows for acceptance/rejection of pre-note by RDFI
Paper checks will continue to be generated
Direct Deposit eligibility begins
Pre-arranged Payment and Deposit Entry (PPD)
ACH Credits only – voids/refunds will not be processed
electronically
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EFT Processing Workflow
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Setup
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Checking Account Maintenance (SB)
Checking Account Number
Line 16 – ABA Routing Number
Line 17 – EFT Trace Number
Line 22 – EFT Payment Method to ACH
Four new display-only EFT processing fields
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File Create Date
File Create Time
File ID Modifier
Batch Number
Copyright © 2014 TriZetto Corporation
Checking Account Maintenance (SB)
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EFT Participant Maintenance (EFTPM)
Create EFT receiver information
Member / Provider / Vendor
Bank information
RDFI routing number
Account number / Account type
System date range-based revision levels
Financial institution changes
Pre-note information
One-to-many source financial institution (ODFI) records
ODFI routing numbers and account numbers
Date pre-note sent for each ODFI
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EFTPM – Member Record
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EFTPM – View Records
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EFTPM Deletion Rules
Multiple future date ranges can be deleted
Gaps in date ranges allowed
Records where system date is greater than or
equal to Effective From date cannot be deleted
Audit trail
Anti-fraud measure
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Pre-Note Processing
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EFT Pre-Note Processor
Generate EFT pre-notification authorization records
One-to-many ODFI-specific records
Check group/bank account driven
Group Revision Maintenance (GR)
Plan Benefit Overlay (Plan Builder PPO / GBO)
Flex Control Maintenance (FSGM)
Disability Group Revision Maintenance (JGRM)
HMO Revision Maintenance (HMR)
Billing Commission/Fund Maintenance (BCFM)
Billing Installation Maintenance (BIM)
Process only when new EFTPM records are created
Cannot be run concurrently with EFT File Create
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EFTPNP
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EFTPM After EFTPNP
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EFT Processing
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EFT File Create
Creates output files to communicate
Pre-notification authorization records
Electronic fund transfer payment records
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Output based on NACHA ACH Format
Separate output file for each ODFI
Printable summary report
Maximum number of 36 output files per ODFI per
system date
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AGPMAIN
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EFT File Create (EFTFC)
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EFTFC File Naming Conventions
Dynamically named output files
Each output file name begins with ACH
ODFI Routing Number
Year (CCYY format)
Ordinal Date
File ID Modifier
ACH1234567892013213A
Represents an output file created on August 1, 2013 for
Routing Number 123456789 and File ID Modifier A
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EFTPM After EFTFC
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EFT File
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Sample EFT Output in NACHA ACH format
101 200706061 20070606110071219010094101
5220Pete Foskaris - 000000000001
1360000000PPDCLAIM PMNT
0000000001200706060000001
62345454545495415985641859854000000000 0001856200
0200706068464433
62345454545495415985641859854000000000 0001856200
0200706068464434
62345454545495415985641859854000000000 0001856200
0200706068464435
623985416528965410569851
000000000 0004686200
0200706068464436
623985416528965410569851
000000000 0004686200
0200706068464437
623985416528965410569851
000000000 0004686200
0200706068464438
62312345678998765432101234567000000000 0004712200
0200706068464439
62312345678998765432101234567000000000 0004712200
0200706068464440
62312345678998765432101234567000000000 0004712200
0200706068464441
822000000904690256250000000000000000000000001360000000
200706060000001
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999999
9000001000001000009 0469025625000000000000000000000000
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ACH File Format
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ACH File Format
File Header Record
Company/Batch Header Record
Entry Detail Records
Company/Batch Control Record
Company/Batch Header Record
Entry Detail Records
Company/Batch Control Record
File Control Record
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File Header Record Contents
Immediate Destination – SB Line 16 Routing
Number
Immediate Origin – SB Line 16 Routing Number
File Creation Date – Store date in new SB field
File Creation Time – Store time in new SB field
File ID Modifier – Store in new SB Field
Permits multiple file created on same date and participants
Store last used by date
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Company/Batch Header Record Contents
Company Name – SN-1 Line 01 Name
Company Discretionary Data – SB Account Number
(ODFI)
Company Identification – SN-1 Line 06 Federal ID
Company Entry Description (based on ck type)
CLAIM PMNT (A – EFT claim ck, O – EFT enrollee voucher ck)
AGENT COMM (Z – EFT billing commission check)
CAPITATION (U – EFT capitation check)
FLEX SPNDG (X – EFT flex check)
ODFI Identification – SB Line 16 Routing Number
First 8 characters only
Batch Number – Store in new SB field
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Entry Detail Record (PPD) Contents
RDFI Identification – Routing Number for
receiver’s financial institution
RDFI Account Number – Account Number for
receiver
Amount – EFT check amount
Nochk and nopay records/amounts will not be written
Individual Identification Number
Enrollee internal sequence number and employer group ID
Vendor internal sequence number
Provider internal sequence number
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Entry Detail Record (PPD) Contents (cont’d)
Individual Name – Payee Last Name
EDM (if applicable), otherwise EM
PM Line 03 (if applicable) otherwise Line 01
BVM Line 01
Trace Number
Sequentially updated by ODFI Routing Number
Last Trace Number used will be stored in new SB field
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Company/Batch Control Record Contents
Entry Count – Total of all PPD Entry Detail
Records
Total Credit Entry Dollar Amount
Company Identification – SN-1 Line 06 Federal ID
ODFI Identification – SB Line 16 Routing Number
First 8 characters only
Batch Number – Store in new SB field
Sequentially assigned
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File Control Record Contents
Batch Count
Total number of Company/Batch header records
Entry Count
Total number of all Entry Detail Records
Total Credit Amount
Total of Credit Entry Detail Records dollar amounts
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NACHA ACH Rules Information
Basic online access
Requires user self-registration
http://www.achrulesonline.org/index.aspx
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Workshop Survey
We would like to extend you an opportunity
to provide candid feedback.
During the workshop you should have received an e-mail
notification for you to take an on-line survey.
If you could take a few minutes to complete at this time ,
we would greatly value your feedback. For your convenience,
the survey will be available throughout the remainder of the conference
should you not be able to complete immediately.
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Thank You!
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